Pressure ulcers among elderly hospital patients constitute an important clinical problem, in terms of frequency, severity, and health care costs. The incidence rate of pressure ulcers among patients aged 65 years or more in acute care settings is between 7% and 13%. Patients with pressure ulcers require significantly more nursing time, remain hospitalized for longer periods, generate higher hospital charges, and use more post-discharge health care resources than comparable patients without pressure ulcers. In the United States, an estimated $6.4 billion per year are spent on treating patients with pressure ulcers. The major extrinsic factors related to the etiology of pressure ulcers are immobility, shearing, and friction. Although many of the diagnostic and therapeutic procedures that patients undergo while in the Emergency Department (ED) involve exposure to these three factors, there has been almost no research examining the association between exposure to ED procedures and the risk of pressure ulcers. The purpose of the proposed study is to estimate the incidence rate of hospital-acquired pressure ulcers in elderly medical patients admitted through the ED, and to assess the impact of length of stay in the ED and of procedures experienced during the ED stay on pressure ulcer risk. A cohort of approximately 4,193 patients aged 65 or more admitted to the medical service from the ED at the Hospital of the University of Pennsylvania and Presbyterian Medical Center will undergo a full-body skin examination on the third day of hospitalization to ascertain their pressure ulcer status. The case group (n=268) will be made up of patients with one or more hospital-acquired pressure ulcer(s) while controls (n=536) will be randomly selected from among patients who are found not to have any pressure ulcers. The two groups will be compared with respect to the frequency of exposure to various ED-related factors (e.g., length of stay in the ED of five hours or more, transport by ambulance, use of an immobilizing device). Potentially important confounding variables (e.g., nutritional status, cognitive status, and severity of disease) will be carefully measured and adjusted for in the statistical analysis. The investigators state that the proposed research will help to identify ED procedures that are associated with increased risk. They further state that ways can then be sought to modify how these procedures are performed and that patients who have undergone these procedures can be targeted for cost-effective preventive interventions. They conclude that the present research is a first step towards addressing a common and serious problem, improving the quality of life of elderly hospital patients and reducing the cost of hospital care.